Form Hsmv 82137 PDF Details

In the State of Florida, the handling of derelict motor vehicles and trailers, especially in the context of their sale, demolition, or recycling, is governed by specific regulations to ensure environmental safety and legal compliance. The HSMV 82137 form plays a pivotal role in this process. Designed by the Florida Department of Highway Safety and Motor Vehicles - Division of Motorist Services, this form serves multiple critical functions. It is the mandatory document for owners or sellers who intend to dispose of a derelict motor vehicle or trailer, valued under specific thresholds, to a licensed salvage motor vehicle dealer or a registered secondary metals recycler in the absence of a title, salvage title, or certificate of destruction. The form facilitates the application for an Original/Duplicate Derelict Motor Vehicle Certificate and concurrently requests the cancellation of the vehicle's title, thereby preventing its future registration or titling. It comprehensively captures essential details such as the vehicle's description, owner/seller information, and the acknowledgment of no undisclosed liens. Moreover, it mandates the involvement of certified transporters for the vehicle's delivery to the salvage dealer or recycler, reinforcing the legal traceability of the transaction. This intricate process underscores the state's commitment to regulating the disposal of derelict vehicles and trailers, safeguarding interests of legal ownership, and promoting environmental stewardship.

QuestionAnswer
Form NameForm Hsmv 82137
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesetals, flhsmv, florida derelict form, elict

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STATE OF FLORIDA

DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES - DIVISION OF MOTORIST SERVICES

SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE

www.flhsmv.gov/offices/

APPLICATION FOR AN ORIGINAL/DUPLICATE

DERELICT MOTOR VEHICLE CERTIFICATE AND REQUEST TO CANCEL TITLE

This form must be used by the owner/seller of a derelict motor vehicle/trailer who is arranging for the delivery and/or sale of the derelict motor vehicle/trailer to a licensed salvage motor vehicle dealer or a registered secondary metals recycler when the title, salvage title or certificate of destruction is not available. The derelict motor vehicle must be worth less than $1,000 or the derelict trailer (TL) must be worth less than $5,000 and must be at least ten model years old (count model year as year one). This form may also be used to apply for a duplicate Derelict Certificate.

VEHICLE/TRAILER MAY NEVER BE TITLED AGAIN AND MUST BE DISMANTLED OR SCRAPPED.

SECTIONS 1, 2, AND 3 SHOULD BE COMPLETED IF APPLYING FOR AN ORIGINAL DERELICT CERTIFICATE.

SECTION 1 SHOULD BE COMPLETED BY THE SALVAGE DEALER/RECYCLER, IF APPLYING FOR A DUPLICATE DERELICT CERTIFICATE.

Check One:

Owner must complete this section:

ORIGINAL

SECTION 1

DUPLICATE

VIN:

Year:

Make:

Body:

Color:

 

Purchase Price:

 

 

 

 

 

 

 

 

Name of Owner/Seller:

 

Owner/Seller’s Driver License/ID Card Number and State of Issue:

 

 

 

 

(Legible copy must be attached.)

 

 

 

 

 

 

 

 

 

 

 

 

Address of Owner/Seller:

 

 

 

 

 

 

THUMB PRINT SECTION

 

 

 

 

 

 

If the seller is not the owner of record

 

 

 

 

 

 

of the above described vehicle, the

I certify that I am the owner/seller of the derelict vehicle/trailer described above and the title, salvage title, or certificate of

 

 

licensed salvage dealer or registered

destruction is not available. I certify that this vehicle is either a motor vehicle (worth less than $1,000) or a trailer (worth less than

 

secondary metals recycler at the time

$5,000) which is at least ten model years old, (required under s. 319.30, Florida Statutes). I certify that there are no undisclosed

 

of sale must obtain a smudge-free

 

right thumb print or other digit if the

liens against this vehicle. If I am the seller, I further attest that possession of the motor vehicle/trailer was obtained through lawful

 

seller has no right thumb.

means along with ownership rights. I understand this statement will be filed with the Florida Department of Highway Safety and

 

 

 

Motor Vehicles and I am authorizing my title record to be cancelled preventing this vehicle/trailer from ever being titled again.

 

 

 

I hereby authorize _____________________________________________________ of _____________________________________________________________

 

 

 

(Print Name of Driver)

 

(Print name of Transporter Business)

 

 

 

 

to act on my behalf and transport the vehicle described above to a licensed salvage motor vehicle dealer or registered secondary metals recycler.

 

 

 

 

 

 

 

 

Under Penalties of Perjury, I Declare That I Have Read The Foregoing Document and That The Facts Stated In It Are True.

 

 

 

 

 

 

 

 

 

 

Signature(s) of Owner(s):

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

SECTION 2

This section must be completed by the transporter being hired to transport the vehicle for the owner/seller to a licensed salvage motor vehicle dealer or secondary metals recycler and cannot be used for a vehicle being towed from private property for third parties or being purchased by towing operators. If the owner/seller or the salvage motor vehicle dealer or secondary metals recycler transports the motor vehicle/trailer in lieu of a transporter, this section may be left blank.

Transporter (when applicable) must complete this section:

Location of Pickup:

Name of Company or Person Transporting:

Name of Driver Transporting:

Florida DL Number of Person Transporting:

I certify the owner/seller of the vehicle described above provided proper personal identification, completed section one of this form and signed the form in my presence when I picked the vehicle up at the above location.

Under Penalties of Perjury, I Declare That I Have Read The Foregoing Document and That The Facts Stated In It Are True.

Signature of Transporter

Date:

Printed Name:

Person’s Business Title:

SECTION 3

The licensed salvage motor vehicle dealer or registered secondary metals recycler must complete this section:

Name of Business Acquiring the Vehicle:

Licensed Salvage Motor Vehicle Dealer License Number or Secondary Metals Recycler’s Registration Number:

Licensed Salvage Motor Vehicle or Secondary Metals Recycler’s E-mail Address:

I am notifying the Florida Department of Highway Safety and Motor Vehicles, as required by law, within 24 hrs. (excluding weekends/holidays) of receiving the derelict motor vehicle/trailer by delivering this completed form to a tax collector's office/license plate agency. I certify that I paid less than $1,000 for the motor vehicle or less than $5,000 for the trailer described in this application and agree to hold the motor vehicle/trailer for three (3) business days (excluding weekends/holidays) after the Derelict Certificate is issued before dismantling or destruction. I acknowledge it is a punishable felony of the third degree, as provided in s. 775.082, 775.083 or 775.084, Florida Statutes, if this statement contains false information.

Under Penalties of Perjury, I Declare That I Have Read The Foregoing Document and That The Facts Stated In It Are True.

Signature of Buyer:

Date:

Printed Name:

Person’s Business Title:

Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/

HSMV 82137 (06/11) S

www.flhsmv.gov

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